Provider Demographics
NPI:1730146911
Name:POUR, SHEILA J (PA-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:J
Last Name:POUR
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:11384 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-4887
Mailing Address - Country:US
Mailing Address - Phone:804-730-3355
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:MCGUIRE VAMC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5553
Practice Address - Fax:804-675-5778
Is Sole Proprietor?:No
Enumeration Date:2006-04-30
Last Update Date:2011-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840462363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018684F36Medicare PIN